A Study Of Semi-permanent Indwelling Central Venous Catheter About Its Influence On The Micro-inflammatory State In The Uremic Patients Of Maintenance Hemodialysis

Objectives:To assay the factors of the micro-inflammatory state of plasma in pre-dialysis Chronic Renal Failure patients,maintenance hemodialysis patients with vascular access(VA) and maintenance hemodialysis patients with semi-permanent indwelling central venous catheterization, investigate the impact of Semi-permanent cuffed central venous catheter for hemodialysis about the micro-inflammation in uremic patients of maintenance hemodialysis, and the relationship between catheter with other uremic indicators, at the same time discuss the clinic significance about them.Methods:Choose pre-dialysis chronic renal failure patients 12 cases,maintenance hemodialysis patients with VA 12 cases and patients with semi-permanent indwelling central venous catheterization 12 cases, blood samples were collected to measure micro-inflammatory state related factors such as high sensitive C-reactive protein,interieukin-6,tumor necrosis factor-a, uremic toxins such as blood urea nitrogen and serum creatinine,β2-microglobulin levels. Compare the difference of micro-inflammatory state factors and uremic toxins between each group, do correlation analysis, and compare the results with normal group.Results:1,Compared with healthy individuals, levels of serum hsCRP,IL-6,TNF-αincreased significantly both in MHD patients and pre-dialysis chronic kidney disease patients groups, there were statistically significant, P<0.05. 2,Serum IL-6,TNF-αlevels in MHD patients were much higher than pre-dialysis chronic kidney disease patients, appeared significant disparity in statistically, P<0.01.3,Among MHD patients, TNF-a levels in patients with semi-permanent indwelling central venous catheter were higher than in patients with vascular access(VA), there were statistically significant, P<0.01.4,Correlation analysis showed that, serum hsCRP significantly positive correlated with IL-6,TNF-α,BUN,SCr andβ2-MG (respectively r=0.645, P<0.01; r=0.633, P<0.01; r=0.590, P<0.01; r=0.639, P<0.01; r=0.671, P<0.01), and negatively correlated with HCO3-,Hb,ALB (respectively r=-0.305, P<0.05:r=-0.486, P<0.01; r=-0.464, P<0.01).Conclusions:1,The levels of serum hs-CRP,IL-6,TNF-αincreased significantly suggesting the existence of micro-inflammatory state in chronic kidney disease patients (including pre-dialysis patients and MHD patients).The levels of serum hs-CRP,IL-6,TNF-αin MHD patients were higher than in pre-dialysis chronic kidney disease patients.2,Among MHD patients, the levels of serum hs-CRP,IL-6,TNF-αin patients with semi-permanent indwelling central venous catheter were higher than in patients with vascular access(VA).3,In CKD patients, the levels of hs-CRP,IL-6,TNF-αare positively correlated with levels of uremic toxins such as BUN,SCr andβ2- MG, while negatively correlated with levels of HCO3-,Hb,ALB. The presence of micro-inflammatory state in CRF patients has an important impact on their nutritional status, and may be correlated with the acidosis degree.